Early autologous cranioplasty after decompressive hemi-craniectomy for severe traumatic brain injury

Objective: To evaluate the outcome of early replacement of autologous bone flap for decompressive hemicraniectomy in severe traumatic brain injury patients. Methods: The observational cross-sectional prospective study was conducted at the Neurosurgical Unit of the Combined Military Hospital, Rawalpindi, Pakistan, from July 2011, to June 2014, and comprised patients who underwent cranioplasty after decompressive hemicraniectomy for trauma. Patients over 20 years of age and of either gender were included. Cranioplasty was timed in all these patients using native bone flap preserved in the abdominal wall after decompressive craniectomy. Parameters recorded were mortality, wound infection, subdural collection, wound dehiscence, ventriculomegaly, bone resorption, cosmetic deformity and neurological outcome. SPSS 17 was used for data analysis. Results: Of the 30 patients in the study, 28(93.3%) were males. The overall mean age was age 32.03+/-8.01 years (range: 20-48 years). Mean cranioplasty time was 66.2+/-11.50 days (range: 44-89 days). Major infection necessitating bone flap removal was found in 1(3.33%) patient, while minor scalp wound infections, treated with antibiotics and dressings were found in 2(6.66%). Cosmetic18 deformity was seen in 3(10%). Improved neurological outcome was noted in 21(70 %) patients; 6(20%) survived with a moderate to severe disability and 3(10%) remained in a vegetative state. No mortality was found after the procedure. Conclusion: Early autologous bone replacement for decompressive hemicraniectomy in severe traumatic brain injury patients offered cost-effective, acceptable surgical and improve dneurological outcome.